Healthcare Provider Details

I. General information

NPI: 1780512988
Provider Name (Legal Business Name): SUNRISE RESIDENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6371 WASHINGTON ST NE
FRIDLEY MN
55432-5031
US

IV. Provider business mailing address

6371 WASHINGTON ST NE
FRIDLEY MN
55432-5031
US

V. Phone/Fax

Practice location:
  • Phone: 763-204-4697
  • Fax:
Mailing address:
  • Phone: 763-204-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: HAMZA SUFIAN
Title or Position: OWNER
Credential:
Phone: 612-406-9257